U.S. Healthcare Needs Revamp, IOM Says

The American healthcare system needs to move from one that wastes hundreds of billions of dollars each year to one that provides the best care at a lower cost, according to a new report from the Institute of Medicine.

To do that will require a shift to a "continuously learning" healthcare system that not only incorporates the latest scientific knowledge, but also patient preference, improved payment incentives, and better use of available technologies, said Mark Smith, MD, president and CEO of the California Healthcare Foundation and chair of the committee that wrote the report.

"How is it possible that we spend more money on healthcare than any other country ... and at the same time we do not attain the same results in healthcare outcomes and performance that others achieve?" Harvey Fineberg, MD, PhD, president of the IOM, said during a webcast press briefing at the National Press Club.

The report estimated that $750 billion -- about 30% of total U.S. healthcare costs -- was wasted in 2009 on unnecessary services, excessive administrative costs, fraud, and other problems.

Reform is sorely needed, Smith said, given that healthcare spending accounts for 18% of the U.S. gross domestic product (GDP) -- a higher percentage than in any other country in the world.

"It would be one thing if we get good value for that money, but there's ample evidence that there's tremendous waste," Smith said.

Yet cost is not the only driver of the need for change, Smith said. Another is the growing complexity of clinicians' everyday life, in terms of both an increasing knowledge base and more fragmented care.

For instance, Smith said, about 800,000 journal articles are published every year, an impossible burden of required reading that prevents the speedy uptake of the latest advances into the clinic.

"It is quite impossible to keep up with the literature in our own little specialties" while also having to treat patients with multiple comorbidities, report committee member Bruce Ferguson, MD, of East Carolina Heart Institute, said during the briefing.

At the same time, patients are receiving fragmented care, with elderly patients seeing an average of seven doctors across four practices every year. And some of those patients can be on up to 19 doses of medication each day, Smith said.

Moving to a "learning" healthcare system should help fix both cost and complexity issues with its focus on continuous improvement, Smith said. Its aim would be to systematically capture and disseminate lessons "from every care experience and new research discovery," according to the report -- an aspect that would be greatly aided by electronic health records (EHRs).

The system would be defined by its reliance on real-time access to scientific knowledge as well as a greater emphasis on a patient-physician relationship in which patients are informed and engaged, Smith said.

It would also dictate improved incentives that focus on better health outcomes instead of greater volume of clinician visits and procedures, he said.

And the culture of an institution will also play a key role: "You can't underestimate the importance of a culture of learning and support," Smith said, noting that model institutions such as ThedaCare in Wisconsin and Denver Health have a focus on culture driven by "bold and consistent leadership."

Moving to this learning system, he added, would be enabled by advances in computing power, connectivity, and organizational management, as well as a greater focus on teamwork.

Experts contacted by MedPage Today and ABC News said that many of the issues raised by the IOM report transcend the talking points raised by the current healthcare reform debate in Washington.

"Whether Obamacare survives or is killed, we will still need to move toward a system in which every clinical decision for every patient is based on the best available science, not on the financial needs of a given player," Jerry Avorn, MD, of Harvard, said in an email.

Ken Thorpe, PhD, of Emory University in Atlanta, said the issues that need to be discussed "are not partisan. They are issues of how best to prevent disease, faster and more comprehensive disease detection, and building an evidence-based delivery model that more effectively manages and engages chronically ill patients."

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